PD subtypes

Surat Tanprawate, MD
Division of Neurology
Chiangmai University

Gibb et al, 1988, Table from Litvan et al, 2003

PD- diagnostic criteria

Diagnostic
accuracy to 82%

Gibb et al, 1988, Table from Litvan et al, 2003

PD subtypes

Genetic vs non-genetic

Predominant motor feature

Benign tremurous PD, TP-PD, gait predominant PD

Age of onset

Young onset vs adult onset

Cognitive features

Rate of progression

Benign tremulous parkinsonism

Tremor

TP-PD

Mixed subtype
Akinetic-rigid syndrome

Postural instability gait disorder

(PIGD)

Akinetic-rigid

Motor subtype of PD (usually based on tremor and

postural and gait items on UPDRS

Benign tremulous parkinsonism vs

monosymptomatic resting tremor

benign tremulous parkinsonism = predominant resting tremor

with mild other sign of PD

mono-symptomatic resting tremor (mRT) = resting tremor

without sign of PD

MDS on mRT (Deuschl, Bain, 1998)

1. pure or predominant resting tremor
2. no sign of bradykinesia, rigidity, or problem with stancestability sufficient to diagnose PD
3. tremor duration of minimum 2 years

Benign tremulous parkinsonism vs

monosymptomatic resting tremor

benign tremulous parkinsonism

1. prominent resting tremor that is the first sign and
persistently overshadows other aspects of
parkinsonism
2. non tremor components of parkinsonism that remain
mild
3. absence of gait disorder apart from reduced arm
swing or mild stooping
4. no more than mild progression, except for tremor
Josephs KA. et al. Arch Neurol. 2006;63:354-357

Benign tremulous
parkinsonism

only 40% response to L-dopa

more family history (60%in some study)

slow course of progression

case report response to DBS

Josephs KA. et al. Arch Neurol. 2006;63:354-357

DaTSCAN images
(top left) normal tracer uptake in the putamen and caudate nuclei; then progressively
decreasing uptake in scans from patients with mild (top right), moderate (bottom left),
and severe (bottom right) parkinsonism.
PG Bain J Neurol Neurosurg Psychiatry 2002;72(Suppl I):i3i9

SWEDDs (Scans Without

Evidence of Dopaminergic Deficit)

10% of early Parkinsons disease (PD): normal

dopaminergic functional imaging (SWEDDs
Scans Without Evidence of Dopaminergic Deficit)

favoured SWEDDs: the lack of true bradykinesia,

occurrence of dystonia, and position- and taskspecificity of tremor

favoured PD: re-emergent tremor, true fatiguing or

decrement, good response to dopaminergic drugs
as well as presence of nonmotor symptoms